Sopi january-march 2015 -

Study of Bacteriological Profile and Antibiotic Sensitivity &
Resistance Pattern in Pus Culture Isolates at Tertiary
Care Teaching Hospital in Bhopal
Nidhi Jain, Abhay Joshi, Rakesh Sonawane, Arun SrivastavObjective: To study the bacteriological profile and the pattern of antibiotic sensitivity and resistance in pus culture isolates in a tertiary care teaching hospital in Bhopal. Materials and Methods: Pus specimens submitted to the microbiology laboratory for routine cultures and sensitivity were analyzed prospectively for the duration of 2 months. Antimicrobial susceptibility testing was performed by Kirby-Bauer Disk Diffusion method. Results: Among the total 440 samples analyzed, 319 samples (72.5%) were found to be positive for growth. Out of 319 growths, 286 shows single isolate and 33 shows mixed (double) isolates. Out of these positive samples, 269 samples (84.33%) were positive for
Department of Opharmacology,
Gram negative bacteria while 44 samples (13.8%) were positive for Gram positive
Gandhi Medical College,
bacteria, 4 (1.25%)were positive for both and 2 samples (0.63%) were positive for growth
Bhopal (M.P.) India
other than bacteria i.e. fungal growth. Klebsiella was the most common Gram–negative bacteria isolated & other common Gram-negative bacteria isolated were Pseudomonas
and E.coli species while Staphylococcus aureus & CONS were the commonest Gram–positive bacteria. Gram negative bacteria shows >35% sensitivity to Meropenem,
Imipenem-cilastatin, Cefoperazone and >20% sensitivity to Piperacillin-Tazobactam and Gatifloxacin. They were most resistant to Cefpodoxime, Cefprozil. Gram positive bacteria
were >70% sensitive to Lincomycin and Ampicillin-Sulbactam while most resistant to
Clarithromycin, Sparfloxacin, Gatifloxacin. Conclusion: We must use antibiotics rationally and judiciously as these are precious and limited resources. So in order to combat the menace of resistant microorganisms, we should join hands to formulate safe and effective antibiotic policies at loco-regional as well as national level. Because, if such type of indiscriminate, irrational and widespread use of antibiotics is allowed to continue, the day is not far when the resistance rates among the micro-organisms will become so high that the most innocuous looking infections may prove fatal for life.KEYWORDS: Bacteriological profile, antibiotic resistance, sensitivity, pus.
development of resistance [2].
Infectious diseases have been the leading cause of death all
Multi-drug resistant strains have become a matter of
over the world. The discovery of antibiotics opened a
serious concern. The bugs producing Extended spectrum
new era in the treatment of infectious diseases. But betalactamase (ESBL) and carbepenamase are really fatal the concurrent development of antibiotic resistance as they confer resistance to the penicillins, cephalosporins illustrated the ability of the microorganisms to grow and even to carbapenems [3].The day is not far when these and survive under unfavorable conditions [1].
bacteria will get resistant to the new molecules like
Development of antimicrobial resistance is increasing day
tigecyclin, dorepenam and daptomycin owing to their
by day at faster pace than it can be controlled. Inadequate
indiscriminate and widespread use [4]. For treating
antibiotic with suboptimal dose and incomplete course has
antibiotic resistant infection, many billions of dollars are
adverse outcome and increases the possibility of
being spent every year. Therefore there is a need for regular screening of microorganisms causing various
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Jain N et al : Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary Care Teaching Hospital in Bhopal
infections and to characterize their antimicrobial gatifloxacin, linezolid, lincomycin, clindamycin, sensitivity and resistance pattern to commonly used vancomycin, ampicillin/sulbactam, roxithromycin, antibiotics at loco-regional, national and global levels lomefloxacin, clarithromycin, teicoplanin, moxifloxacin. to guide the clinicians to select an adequate antibiotic
The antibiotics tested for Gram negative bacilli (GNB)
for empirical treatment of infections [1].
were cefoperazone, cefpirome, cefpodoxime, cefprozil,
For selecting an effective antimicrobial agent for an ceftizoxime, gatifloxacin, imipenem/cilastatin, infection, knowledge of the potential microbial meropenem, moxifloxacin, piperacillin/tazobactam, pathogen, an understanding of the pathophysiology of
ticarcillin/clavulanic acid, tobramycin, sparfloxacin,
the infectious process and pharmacology of the levofloxacin. Data of micro-organisms analysed and its intended therapeutic agents are required [5]. In addition
resistance and sensitivity pattern was recorded.
place to place variation has also been found in the Results and Discussionantimicrobial susceptibility patterns [6]. A number of
Total 444 samples of pus were collected during the study,
studies have been carried out in the western countries to
out of these 319 samples showed significant growth of
monitor antimicrobial resistance at national level [7, 8].
organisms. Four samples were contaminated so were
The academic and educational value of these studies is
excluded from the study. The positivity rate was found to
particularly useful for microbiologists and infectious
be 72.5% which was comparable to those reported by the
disease clinicians.
other similar studies. A study done by Muluye et al
Materials and Methods
reported pus culture positivity rate 70.2% [7], while
This cross sectional observational study was conducted at
another study done by Kaup et al, reported it 73.5% [1]. In
Hamidia Hospital, Gandhi Medical College, Bhopal, a
our study, out of 319 samples, 286 (89.7%) were single
tertiary care teaching hospital. The Pus specimens
isolates & 37 (11.6%) were found to be mixed (double)
collected from the various sites of infection routinely
submitted for culture and sensitivity during the period of
Gram negative Bacteria were much more common than
May to June 2014 to the microbiology laboratory of the
Gram Positive organisms. GNB were grown in 269
hospital were analyzed. Processing of samples and the samples which constituted 84.33% of the total samples identification of the isolates were performed by while 44 samples were positive for GPC which constituted conventional methods.
13.8%. Four samples (1.25%) were having both types of
The antibiotic resistance and sensitivity test was
the growth i.e. GNB & GPC and 2 samples were having
performed by Kirby- Bauer's disk diffusion method on
fungal growth. Other similar studies also have the
Mueller Hinton agar plates. The antibiotics tested for
consistent results. [1, 9]
Gram positive cocci (GPC) were cefaclor, sparfloxacin,
Klebsiella was the predominant organism isolated from
Figure1: Percentage Growth among Pus Specimens
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Jain N et al : Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary Care Teaching Hospital in BhopalFigure 5: Antimicrobial sensitivity and resistance pattern among GPC
the pus culture which constituted 46.4% (148 samples).
resistance to Imipenem/cilastatin and Meropenem was
Second most common organism isolated was
quite higher in our study when compared to the previous
Pseudomonas (27.3%) followed by E.coli (13.8%). Next
study done by Kaup et al in which they were 100%
common organism isolated was Staphylococcus aureus
sensitive [1].
which was most common Gram Positive bacteria isolated,
Gram positive bacteria were somewhat less resistant to
constituted 11.3% of total growths. In another similar
antibiotics than Gram negative bacteria according to our
study, the most common GPC isolated was Staphylcoccus
study. Percentage resistance was highest for
aureus and most common GNB was E.coli followed by
Clarithromycin (79.2%), to Sparfloxacin (72.9%) and
Pseudomonas [1]. In our study other organisms isolated
Gatifloxacin (72.9%). Gram positive bacteria were most
were non lactose fermenting bacteria (NLF Bacteria),
sensitive to Lincomycin and Ampicillin/sulbactam with
coagulase negative staphylococci (CONS), proteus,
their sensitivity rates approaching 77.1% and 72.9%
acinetobacter, citrobacter, streptococci.
Our study showed that Gram negative bacteria have
become highly resistant to cephalosporin group of drugs,
We reported our results regarding the trends in the pus
of which they were most resistant to Cefpodoxime
culture isolates collected over the period of two months.
(96.3%), Cefprozil (94%), Cefpirome (87.4%), and
Most of the infectious sites from where the pus was
Ceftizoxime (86.2%). Resistance to Ticarcillin/clavulanic
collected were found to be gram negative bacillary
acid and Flouroquinolone group of drugs was also quite
infections. Organisms including Klebsiella, Pseudomonas
high. According to our study, most sensitive antibiotics for
and E.coli among GNB and Staphylococcus aureus among
GNB were found to be Imipenem/cilastatin and
GPC were the predominant isolates. This is the scenario in
Meropenem. But percentage resistance in these newer
most of the hospitals, medical institutes and centers in
antibiotics has also found to be 60.6% and 59% for
India, which is in stark contrast with the western countries
Imipenem/cilastatin and Meropenem respectively. These
where the major share of hospital associated infections is
findings were consistent with the results obtained by
constituted by gram positive organisms like
previous similar study done by Kaup et al [1],but the
Staphylococcus aureus since the 1980's [10].
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Jain N et al : Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary Care Teaching Hospital in Bhopal
Recently, an extensive and indiscriminate use of
Cephalosporin group of drugs especially 3rd generation
Imipenem/cilastatin and Meropenem.
cephalosporins and quinolones in community has
In order to rationalize the administration of empirical
contributed to very high resistance rate in GNB. Even the
therapy before the results of culture are available,
newly introduced 4 generation cephalosporin like
knowledge of the most common causative microbial
Cefpirome has got very high resistance rate as it has been
organisms and their antimicrobial sensitivity and
Table 1: Antimicrobial sensitivity and resistance percentage among gram-negative bacilli (GNB)Table 2: Antimicrobial sensitivity and resistance percentage among gram-positive cocci (GPC)
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Jain N et al : Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary Care Teaching Hospital in Bhopal
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